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Comorbid gastric adenocarcinoma and gastric and duodenal Strongyloides stercoralis infection: a case report.

Seo AN, Goo YK, Chung DI, Hong Y, Kwon O, Bae HI - Korean J. Parasitol. (2015)

Bottom Line: A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues.Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever.The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Deagu 700-721, Korea.

ABSTRACT
Strongyloides stercoralis can cause systemic infection, termed strongyloidiasis, and gastrointestinal ulcer disease in immunocompromised patients. However, to our knowledge, there are no reported cases of comorbid gastric adenocarcinoma and S. stercoralis infection. Here, we report a case of an 81-year-old Korean man who presented with S. stercoralis infection coexisting with early gastric adenocarcinoma (T1aN0M0). S. stercoralis eggs, rhabditiform larvae, and adult females were observed in normal gastric and duodenal crypts. They were also observed in atypical glands representative of adenocarcinoma and adenoma. Preliminary laboratory tests revealed mild neutrophilic and eosinophilic leukocytosis. A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues. Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever. The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far. The fact that S. stercoralis infection may be fatal in immunocompromised patients should be kept in mind when assessing high-risk patients.

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Related in: MedlinePlus

Histology of the biopsied stomach and duodenal tissues demonstrating a parasitic infection. Multiple eggs, adult females, and larvae of Strongyloides stercoralis are seen in the crypts of the stomach (A) and duodenum (B) (×20 objective).
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f2-kjp-53-1-95: Histology of the biopsied stomach and duodenal tissues demonstrating a parasitic infection. Multiple eggs, adult females, and larvae of Strongyloides stercoralis are seen in the crypts of the stomach (A) and duodenum (B) (×20 objective).

Mentions: An 81-year-old Korean man presented with weight loss, poor oral intake, and abdominal discomfort for 3 months in November 2013. Although the patient had hypertension and diabetes mellitus for several years and had been treated with standard medication, he was relatively healthy until recently. Physical examination showed no signs of fever, chills, diarrhea, abnormal bowel movement or sound, or skin rash. Furthermore, the patient did not report any previous intake of alcohol, tobacco, herb mediation, or inhaled corticosteroids. In addition, he had no significant family history or recent history of travel to tropical or subtropical regions. Esophagogastroduodenoscopy revealed chronic atrophic gastritis with intestinal metaplasia and multiple erosions in the stomach; in particular, an ulcerative lesion, suggestive of type IIc early gastric cancer, was observed in the anterior wall of the antrum, and an atrophic lesion was observed in the duodenum (Fig. 1). Microscopic examination of a biopsy specimen from the gastric mass in the antrum revealed a well-differentiated adenocarcinoma as well as parasite eggs, rhabditiform larvae, and adult worms presumably of S. stercoralis in normal gastric pits. Scattered eosinophils were not generally observed in the antrum (Fig. 2A); however, some parasite eggs and adult worms were observed along with scattered eosinophils in the mucosa of normal duodenal pits (Fig. 2B).


Comorbid gastric adenocarcinoma and gastric and duodenal Strongyloides stercoralis infection: a case report.

Seo AN, Goo YK, Chung DI, Hong Y, Kwon O, Bae HI - Korean J. Parasitol. (2015)

Histology of the biopsied stomach and duodenal tissues demonstrating a parasitic infection. Multiple eggs, adult females, and larvae of Strongyloides stercoralis are seen in the crypts of the stomach (A) and duodenum (B) (×20 objective).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384790&req=5

f2-kjp-53-1-95: Histology of the biopsied stomach and duodenal tissues demonstrating a parasitic infection. Multiple eggs, adult females, and larvae of Strongyloides stercoralis are seen in the crypts of the stomach (A) and duodenum (B) (×20 objective).
Mentions: An 81-year-old Korean man presented with weight loss, poor oral intake, and abdominal discomfort for 3 months in November 2013. Although the patient had hypertension and diabetes mellitus for several years and had been treated with standard medication, he was relatively healthy until recently. Physical examination showed no signs of fever, chills, diarrhea, abnormal bowel movement or sound, or skin rash. Furthermore, the patient did not report any previous intake of alcohol, tobacco, herb mediation, or inhaled corticosteroids. In addition, he had no significant family history or recent history of travel to tropical or subtropical regions. Esophagogastroduodenoscopy revealed chronic atrophic gastritis with intestinal metaplasia and multiple erosions in the stomach; in particular, an ulcerative lesion, suggestive of type IIc early gastric cancer, was observed in the anterior wall of the antrum, and an atrophic lesion was observed in the duodenum (Fig. 1). Microscopic examination of a biopsy specimen from the gastric mass in the antrum revealed a well-differentiated adenocarcinoma as well as parasite eggs, rhabditiform larvae, and adult worms presumably of S. stercoralis in normal gastric pits. Scattered eosinophils were not generally observed in the antrum (Fig. 2A); however, some parasite eggs and adult worms were observed along with scattered eosinophils in the mucosa of normal duodenal pits (Fig. 2B).

Bottom Line: A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues.Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever.The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Deagu 700-721, Korea.

ABSTRACT
Strongyloides stercoralis can cause systemic infection, termed strongyloidiasis, and gastrointestinal ulcer disease in immunocompromised patients. However, to our knowledge, there are no reported cases of comorbid gastric adenocarcinoma and S. stercoralis infection. Here, we report a case of an 81-year-old Korean man who presented with S. stercoralis infection coexisting with early gastric adenocarcinoma (T1aN0M0). S. stercoralis eggs, rhabditiform larvae, and adult females were observed in normal gastric and duodenal crypts. They were also observed in atypical glands representative of adenocarcinoma and adenoma. Preliminary laboratory tests revealed mild neutrophilic and eosinophilic leukocytosis. A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues. Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever. The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far. The fact that S. stercoralis infection may be fatal in immunocompromised patients should be kept in mind when assessing high-risk patients.

Show MeSH
Related in: MedlinePlus